Louisiana State University LSU Digital Commons LSU Master's Theses Graduate School 2011 Predicting posttraumatic growth: coping, social support, and posttraumatic stress in children and adolescents after Hurricane Katrina Mark Allen Schexnaildre Louisiana State University and Agricultural and Mechanical College Follow this and additional works at: https://digitalcommons.lsu.edu/gradschool_theses Part of the Psychology Commons Recommended Citation Schexnaildre, Mark Allen, "Predicting posttraumatic growth: coping, social support, and posttraumatic stress in children and adolescents after Hurricane Katrina" (2011). LSU Master's Theses. 3662. https://digitalcommons.lsu.edu/gradschool_theses/3662 This Thesis is brought to you for free and open access by the Graduate School at LSU Digital Commons. It has been accepted for inclusion in LSU Master's Theses by an authorized graduate school editor of LSU Digital Commons. For more information, please contact [email protected]. PREDICTING POSTTRAUMATIC GROWTH: COPING, SOCIAL SUPPORT, AND POSTTRAUMATIC STRESS IN CHILDREN AND ADOLESCENTS AFTER HURRICANE KATRINA A Thesis Submitted to the Graduate Faculty of the Louisiana State University and Agricultural and Mechanical College in partial fulfillment of the requirements for the degree of Master of Arts in The Department of Psychology By Mark A. Schexnaildre B.S., Louisiana State University, 2007 May 2011 TABLE OF CONTENTS Abstract………………………………………………………………………………………...…iii Introduction……………………………………………………………………………………….1 Posttraumatic Growth………………………………………………………………………...2 Posttraumatic Growth in Children and Adolescents………………………………………….3 Posttraumatic Growth and Resilience………………………………………………………...7 Coping and Posttraumatic Growth……………………………………………………………8 Social Support and Posttraumatic Growth……………………………………………………9 Posttraumatic Stress Disorder and Posttraumatic Growth…………………………………...10 Summary and Purpose……………………………………………………………………….12 Method…………………………………………………………………………………………...14 Participants…………………………………………………………………………………...14 Measures……………………………………………………………………………………..14 Demographic Questionnaire………………………….………………………………..14 Posttraumatic Growth Inventory for Children…………………………………………14 UCLA PTSD Reaction Index…………………………………………………………..14 Youth Coping Responses Inventory…………………………………………………...15 Social Support Questionnaire for Children...…………………………………………..15 Procedure…………………………………………………………………………………….15 Results……………………………………………………………………………………………17 Assumptions of Normality…………………………………………………………………...17 Missing Data…………………………………………………………………………………17 Descriptive Statistics and Zero-order Correlations…………………………………………..17 Multiple Regression Analysis………………………………………………………………..18 Curvilinear Regression Analysis……………………………………………………………..18 Discussion………………………………………………………………………………………..19 Limitations…………………………………………………………………………………...22 Clinical Implications…………………………………………………………………………22 References………………………………………………………………………………………..24 Appendix A: Demographic Questionnaire…………..…………………………………………..30 Appendix B: Posttraumatic Growth Inventory for Children……………………..……………...31 Appendix C: UCLA PTSD Reaction Index……....………………...………………..………….33 Appendix D: Youth Coping Responses Inventory……………....………………………..……..35 Appendix E: Social Support Questionnaire for Children……………………….……..……..…37 Vita………………………….……………………………………………………………………39 ii ABSTRACT There is a growing area of research that explores the possibility that negative life events could ultimately result in positive outcomes. However, there exists some debate on whether or not children are capable of experiencing such outcomes. The proposed study examined posttraumatic growth (PTG), positive psychological change in the wake of a traumatic event, in a sample of child and adolescent victims of Hurricane Katrina. Specifically, the roles of coping and social support were studied as predictors of PTG. Additionally, the relationship between PTG and posttraumatic stress disorder, which has been shown to be a complex one, was explored. This study used an existing data set of 94 children and adolescents who lived in Southern Louisiana when Hurricane Katrina made landfall. iii INTRODUCTION Hurricane Katrina resulted in a reported 1,836 deaths and over $80 billion in damages (Beven II et al., 2008). The resulting psychological distress has been thoroughly researched (see Galea et al., 2007). However, the majority of studies focus on negative psychological effects of the storm such as posttraumatic stress disorder (PTSD; Sprang & LaJoie, 2009), depression (McLeish & Del Ben, 2008), substance abuse (Rowe & Liddle, 2008), and aggression (Marsee, 2008). The positive effects of trauma, albeit few, have yet to be adequately explored. Children and adolescents displaced by Hurricane Katrina suffered a great deal of psychological and emotional distress (Kessler et al., 2008; Weems et al., 2007; Spell et al., 2008). Many youths were forced into temporary housing situations with different housemates than previously. They were required to attend new schools far from their homes and friends. Their regular routines were disrupted, and the loss of possessions was great. Research indicated that PTSD symptom severity was measured at high levels in children affected by the hurricane (Hensley & Varela, 2008; Cohen et al., 2009). Although there is considerable research evaluating how Katrina marred the lives of children and their families, there is an emerging area of research that explores positive outcomes, specifically, posttraumatic growth (PTG). Researchers are interested in the possibility that traumatic life events that often result in negative outcomes may also bring about positive change (Helgeson, Reynolds, & Tomich, 2006). Tedeschi and Calhoun (2004) define PTG as “positive psychological change experienced as a result of the struggle with highly challenging life circumstances” (p. 1). The proposed study measured predictors of PTG in children and adolescents as well as explored the relationship between PTG and PTSD. 1 Posttraumatic Growth Tedeschi and Calhoun provide a model of experiencing PTG that details the progression from trauma to growth. According to this model, negative life events can, and often do, result in positive outcomes (Tedeschi & Calhoun, 2004). The model begins with an individual experiencing a traumatic event. If the event is sufficiently distressing, it is said to destroy the individual’s fundamental schemas—beliefs and goals—resulting in extreme emotional distress. In an attempt to alleviate the distress, the individual automatically and without intent, ruminates on the trauma. Because these cognitive processes are often unwanted and intrusive, support from others is sought out, and coping strategies such as self-disclosure emerge. This social support aids greatly in the management of emotional distress and reformation of schemas. Once some of the emotional distress is reduced, the automatic rumination transforms into a more purposeful reflection about how the event has changed the individual. Finally, when the intentional thinking is constructive—finding meaning, finding benefits, reappraisal—personal growth occurs (Tedeschi & Calhoun, 1995). Tedeschi and Calhoun propose three broad areas of change related to PTG: perceived changed in self, a changed sense of relationships with others, and a changed philosophy of life (Tedeschi & Calhoun, 1996). Perceived change in self refers to how individuals see themselves and their self-efficacy beliefs. Trauma victims have reported feeling more self-confident and stronger as a result of negative life events (Collins, Taylor, & Skokan, 1990). Change in relationships with others involves feeling closer to and more appreciative of loved ones. Malinak, Hoyt, and Patterson (1979) found that bereaved adults felt an increased appreciation for their families after suffering the death of a parent. Change in philosophy of life can be seen as 2 taking a new, positive perspective of life. Individuals who experience this kind of change claim to find more fulfillment and pleasure in everyday life (Joseph, Williams, & Yule, 1993). As a measure of PTG, Tedeschi and Calhoun developed the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996). The PTGI contains 21 items and uses a 6-point Likert scale. Individuals rate the degree to which change was experienced from 0, “I did not experience this change as a result of my crisis” to 5, “I experienced this change to a very great degree as a result of my crisis” (p. 459). Through factor analysis, five contributing constructs emerged: New Possibilities, Relating to Others, Personal Strength, Spiritual Change, and Appreciation for Life. Preliminary reliability analysis showed the measure to have strong internal consistency (α = .90). Since its development, the PTGI has been widely used in research studies for measuring adult PTG (see Snape, 1997; Cordova, Cunningham, Carlson, & Andrykowsky, 2001; Sears, Stanton, & Danoff-Burg, 2003), but a single measure of child and adolescent PTG has yet to be identified as a clear standard (Kilmer et al., 2009). Posttraumatic Growth in Children and Adolescents Although most of the PTG research has been conducted with adults, recently the concept has been explored with children and adolescents. For example, variables related to youth PTG have been evaluated in adolescents with cancer (Barakat, Alderfer, & Kazak, 2006), those who experienced the death of a loved one (Ickovics, Meade, Kershaw, Milan, Lewis, & Ethier, 2006), children who were victims of traffic accidents (Salter & Stallard, 2004), college